Bush Prods Lawmakers to Step Up Pace of Medicare Talks

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Bush Prods Lawmakers to Step Up Pace of Medicare Talks

By Robert Pear, The New York Times

September 26, 2003

President Bush intervened in talks on a Medicare drug bill today (September 26), trying to galvanize negotiations that have been slowed by deep disagreements between Republicans from the House and those from the Senate.

After a meeting with lawmakers working on the legislation, Mr. Bush said, "The sentiment was optimistic." He said he believed that they could reach agreement on a comprehensive Medicare bill before Congress adjourns this year.

House and Senate negotiators have set an ambitious schedule, which calls for them to complete work on the bill by Oct. 17. But some lawmakers say the goal is unrealistic, since the conferees have scarcely begun to tackle the hardest issues.

Lawmakers knew all along that Republicans and Democrats had profound ideological disagreements over the role of government, versus that of private health plans, in Medicare. But they say they have been surprised to see the stark differences among Republican members of the conference committee trying to reconcile the bill passed by the House with the one passed by the Senate.

"There's an interesting chasm between House conservatives and Senate conservatives," said a Republican involved in the negotiations.

The legislation, which adds prescription drug benefits to Medicare, is crucial to the elderly, an important constituency in next year's elections. But lawmakers and their aides give wildly differing accounts of how much progress they have made.

The chairman of the conference committee, Representative Bill Thomas, Republican of California, issued a statement on Wednesday saying: "Progress on Medicare continues! House and Senate conferees have already reached agreement on more than one-third of the Medicare bill."

But Senator Max Baucus of Montana , the chief Democratic sponsor of the bipartisan bill passed by the Senate, said today that only "limited progress" had been made.

Frederick H. Graefe, a health care lawyer and lobbyist for more than 20 years, said, "Members of the conference committee tell me that the chances of a big Medicare bill diminish every day and the chances of a smaller bill increase every day."

The 17-member conference committee has held three public meetings, and staff members have held countless sessions behind closed doors. But they have not been debating details of the Medicare drug benefit. Lawmakers and their aides have spent most of the time discussing other issues, like how much to pay rural hospitals and how to give private health plans a larger role in Medicare.

House Republican negotiators, led by Mr. Thomas, are fighting for a provision of the House bill that calls for direct competition between traditional Medicare and private plans starting in 2010. They say the private plans will prove more efficient and will often win such competition.

But conservative Republican senators on the conference committee, like Jon Kyl of Arizona and Don Nickles of Oklahoma , take a very different tack. They also seek more competition between Medicare and private plans, but first, they say, Congress must strengthen the private plans. These senators are willing to put billions of dollars into the private plans so they can compete more effectively, even if the plans cost more than the traditional Medicare program in the next few years.

"Senator Kyl and Senator Nickles want to spend more time, energy and money making sure that private plans get into the Medicare market and stay in," said a Republican negotiator who favors the Kyl-Nickles approach. "Unless you get a robust, vibrant, reliable, stable market in place before 2010, competition won't work."

Senators Kyl and Nickles contend that the House bill does not do enough to bring private plans into the Medicare market. They worry that traditional Medicare has so dominant a position that it might crush its competitors in some parts of the country.

Only 12 percent of Medicare's 40 million beneficiaries — fewer than five million people — are in private plans like health maintenance organizations, and the number has been declining. Forty percent of beneficiaries do not even have access to H.M.O.'s, because they live in areas where none are available.

Bush administration officials have not publicly taken sides in the dispute between House and Senate Republicans. But several members of the conference committee say some administration officials have encouraged Mr. Kyl.

Some lawmakers say Mr. Bush himself has been aloof from the Medicare negotiations. The chief Senate negotiator, Charles E. Grassley, Republican of Iowa, said: "There were many rumors floating around town that the president was not very concerned about this issue. Our meeting today puts that sort of rumor to rest. There's absolutely no truth in that. The president not only wants this legislation; he's willing to expend the political capital to get it done."